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CP2 OBGYN > Mx Labour Part 2 > Flashcards

Mx Labour Part 2 Flashcards

1
Q

How is fetal blood sampling done

A

Amnioscope - tiny amount blood = removed from scalp for pH + BE to be measured

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2
Q

Indicated FBS ((5)

A

Persistent late/variable decelerations on CTG
Persistent fetal tachycardia
Prolonged + persistent early decelerations
Signif meconium stained liquor along w/ any CTG abnorm
Prolonged loss of baseline variability

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3
Q

C/I FBS (3)

A

If risk of infection transmitted from mother
Fetal bleeding diathesis
<34w gestation

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4
Q

FBS - If pH is found to be 7.20-7.25, what should be done

A

Repeat at 30-60 mins

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5
Q

FBS - if pH is found to be <7.2, what should be done

A

Delivery by CSC, ventouse or forceps

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6
Q

FBS - BE value > -8 indicates

A

Metabolic acidosis

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7
Q

What substances can affect FBS results (3)

A

Amniotic fluid
Meconium
Maternal blood

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8
Q

What can the presence of meconium in liquor signify?

A

Signs of fetal distress

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9
Q

Why does meconium staining occur?

A

Stimulation of CNX (parasym) in utero –> foetal gut to contract + anal sphincter to relax

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10
Q

Meconium staining - grade 1

A

Good volume of liquor stained lightly w/ meconium

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11
Q

Meconium staining - grade 2

A

Reasonable volume of liquor w/ heavy suspension of meconium

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12
Q

Meconium staining - grade 3

A

Thick undiluted volume of meconium, pea soup consistency

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13
Q

if meconium is found below the vocal chords, what is this called

A

Meconium aspiration syndrome

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14
Q

What is Meconium aspiration syndrme

A

Neonatal pneumonitis

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15
Q

When is meconium aspiration syndrome likely to be more severe?

A

of assoc w/ acidosis/hypoxia

when meconium = thick

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16
Q

Non-medical pain relief options during labour (6)

A 
Birth attendant 
Maintenance of mobility 
immersion of body T H2O 
Aromatherapy 
Hypnotherapy 
TENS
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17
Q

Inhalation agent used for pain relief during labour

A

Entenox

NO + O2 mix

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18
Q

SE entenox (3)

A

Light-headedness
Nausea
Hyperventilation

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19
Q

What systemic opiates are used for pain relief during labour? (2)

A

Pethidine

Meptid (IM)

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20
Q

SE foetus of systemic opiates during labour

A

Respiratory depression

reverse w/ naloxone

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21
Q

How are epidural anaesthesia delivered

A

Via epidural catheter into epidural space between L3-4/L4-5

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22
Q

Advantages - epidural anaesthesia during labour (3)

A

Only pain free method
If labour too long, can reduce BP
Abolishes premature urge to push

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23
Q

Disadvantages - epidural anaesthesia during labour (10)

A 
Occasionally ineffective 
IV access req 
Transient HOTN (after loading dose)
Mobility reduced - P sores
Urinary retention 
Maternal fever 
Increased need for instrumental delivery 
Pushing needs to be directed 
Active 2nd stage delayed
Transient bradyC
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24
Q

C/I epidural (5)

A 
severe sepsis 
Some spinal abnorm 
Active neuro disease 
Hypovolaemia 
Coagulopathy/anti-coag therapy
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25
Q

How is spinal anaesthesia performed

A

LA into dura mater

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26
Q

Complications spinal anaesthesia

A

HOTN

Total spinal analgesia –> resp paralysis

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27
Q

How is a pudendal nn block performed

A

LA injected biblaterally around pudendal nn

Where it passes ischial spines

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28
Q

Indications - forceps delivery - foetal (3)

A

Foetal distress
Face presentation
Known/suspected foetal bleeding disorder

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29
Q

Indications - forceps delivery - maternal

A 
Prolonged 2nd stage labour 
Prev pathologies: 
> Pre-eclampsia 
> Berry Aneurysm 
> UA
> Brittle asthma 
> Prev pneumothorax
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30
Q

6 steps in forceps delivery

A

1 - anaesthestics for foreceps
2- ensure bladder is empty
3 - feel - is cervix still palpable? which way is head?
4 - select type of forceps
5 - If baby in OA - grease up Neville Barnes forceps + insert
6 - if baby not in correct position - grease up Keilliands forceps + use Wandering method

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31
Q

What are the 2 types of forceps

A

Neville Barnes Forceps - traction (fixed lock)

Kelliands forceps - rotation (sliding lock)

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32
Q

When using Neville Barnes forceps, if you do 3 pulls, and there is no descent, what to do

A

STOP due to damage to facial nn (b/c disproportion)
hence
episiotomy

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33
Q

What is the wandering method

A

When anterior blade is 1st inserted posteriorly and then wandered over the face to lie anteriorly

34
Q

What is asynclitism

A

Oblique malpresentation of fetal head in labour

35
Q

Indications - ventouse delivery (3)

A

If delayed 2nd stage labour b/c mum = exhausted
If delayed 2nd stage labour b/c malposition
If abnorm CTG

36
Q

Method - ventouse delivery

A

KIWI cup
Over posterior fontanelle
Traction downwards initially, changing angle upwards as head crowns

37
Q

how long, from application must a ventouse delivery be complete by?

A

15 mins

38
Q

If foetal head is above ischial spines, what method of delivery must be used

A

CSC

39
Q

Risks of assisted delivery (7)

A 
Laceration to vagina 
Perineal trauma 
Rupture bladder 
Skull fractures 
Chignon (baby)
Brain bleed baby 
Facial palsy
40
Q

What is Chignon

A

Scalp oedema

41
Q

Purpose of episiotomy

A

Increase diameter of vulval outlet

42
Q

What episiotomy technique is used in the UK?

A

Epidural/ perineal infiltration w/ LA

+ Mediolateral incision

43
Q

What must be done after suturing up an episiotomy

A

VE

PR

44
Q

Maternal indications episiotomy (2)

A

Female circumcision

If prev perineal reconstructive surgery

45
Q

Fetal indications episiotomy (4)

A

Instrumental delivery
Breech
Shoulder dystocia
Abnormal CTG

46
Q

What % of mothers have some degree of tear during labour

A

70%

47
Q

1st degree tear

A

SKin only

48
Q

2nd degree tear

A

Skin + perineal mm

49
Q

3rd degree tear

A

Incl partial/complete rupture anal sphincter

50
Q

4th degree tear

A

Anal mucosa

51
Q

Maternal indications CSC (7)

A 
2 previous LSCS
Placenta praevia 
Maternal disease 
Fibroids/ovarian cyst 
Maternal request
Active 1' genital herpes
HIV
52
Q

Fetal indications LSCS (7)

A 
Breech 
Twin pregnancy - 1st not cephalic 
Abnorm CTG/FBS
Selected cases of placental abruption 
Cord prolapse
Delay in 1st stage labour 
Cephalopelvic disproportion
53
Q

What incision is used in LSCS

A

Pfannenstiel incision

54
Q

Steps of LSCS

A 
Regional analgesia 
Pfannenstiel incision 
Empty bladder w/ catheter 
Rectus sheath cut + mm divided 
Uterovesical peritoneum incised 
Lower uterine segment incise transversely, fetus delivered 
IV Oxytocin + placenta + membranes removed 
Uterus closed by absorable suture
55
Q

Risks CSC (7)

A 
Adhesions 
Visceral injury 
Lacerations to babies face 
Infection
Haemorrhage
Gastric aspiration (Mendelsons syndrome)
Thomboembolism
56
Q

What is VBAC

A

vaginal birth after CSC

57
Q

VBAC - risk of scar rupture

A

5%

58
Q

What is shoulder dystocia

A

Normal traction fails to deliver shoulders after head because = too big

59
Q

Complications of shoulder dystocia (2)

A

Brachial plexus damage (Erb’s palsy)

Neonatal mortality

60
Q

RF shoulder dystocia (5)

A 
Diabetes / large baby
Prev baby w/ shoulder dystocia 
Incr BMI 
IOL
Decr maternal height
61
Q

Mx shoulder dystocia

A

Sr obstetrician/paids
Suprapubic P
McRoberts maneouvre
Episiotomy
Transverse shoulder - int rotation of shoulder
If fails:
Grasp post arm. Hand brought down + trunk follows, rotate body using arm
LAST resort - symphisiotomy + replacement of head + CSC

62
Q

Mc Roberts Manoeuvre

A

Leg hyperextesnion onto abdomen

63
Q

Prevalence cord prolapse

A

1/500

64
Q

Complications of cord prolapse

A

Cord spasm –> rapid fetal hypoxia –> mortality

65
Q

RF (5)

A 
Pre-term 
Breech 
Polyhydramnios 
Abnorm lie 
Multiple pregnancy
66
Q

Mx of cord prolapse

A

Prevent compression via finger + tocolytics
If out of vag - keep warm/moist + don’t force back inside
Can push back present part of foetus
Pt on all 4s –> CSC

67
Q

What is amniotic fl embolism

A

When amniotic liquor enters the maternal circulation

68
Q

Consequences amniotic fl embolism (4)

A

Maternal death
Rapid DIC
Pulm oedema
ARDS

69
Q

RF amniotic fl embolism (4)

A

ROM
CSC
TOP
Polyhydramnios

70
Q

Mx amniotic fl embolism

A 
Resus 
O2
Blood - clotting/FBC/e=/Cross match 
Blood + FFP
ICU
71
Q

What is uterine rupture

A

A new tear or rupture of CSC scar

72
Q

PS uterine rupture (5)

A 
Constant lower abdo pain
Decr Fetal HR 
Vaginal bleeding 
Cessation of contraction 
Maternal collapse
73
Q

Complications uterine rupture (5)

A

Foetal extrusion
Masssive internal haemorrhage
Acute fetal hypoxia
Neonatal mortality

74
Q

RF uterine rupture (4)

A

Prev CSC
Prev rupture
Deep myomectomy
Obstructed labour

75
Q

Mx uterine rupture

A

Resus incl fl/bloods/FFP

Urgent laparotomy

76
Q

Preventing uterine rupture (2)

A

Avoid IOL in VBAC

Use transverse CSC

77
Q

What is uterine inversion

A

Fundus inverts into uterine cavity, usually after traction on placenta

78
Q

Complications uterine inversion (3)

A

Pain
Shock
Haemorrhage

79
Q

Mx uterine inversion

A

Attempt to push fundus throguh vagina

Replace HSP

80
Q

RF - seizures in labour (3)

A

PE
Epilepsy
Hypoxia

81
Q

Mx seizures in labour (5)

A 
Open airway 
O2
Cardiopulm resus 
diazepam 
MgSO4 if /b/c PE

CP2 OBGYN (21 decks)

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